Thyroid Medication: Do You Really Need It?


I get it. When you hear the words “thyroid medication” you might bristle. Who wants to take a medication they don’t really need? After all, we hear about problems with medication over-prescribing and the risks of pharmaceutical side-effects all the time. It can be scary to think about starting a medication. And it also may not fit into your ideal self-concept – most of us don’t want to think of ourselves as needing a medication, let alone for our whole lives!

So what do you do if you’re faced with a diagnosis of Hashimoto’s or hypothyroidism and have been prescribed thyroid medication? Or have been so exhausted for so long now, have felt depressed, unfocused, or are still gaining weight despite your best efforts at diet and exercise – and now you’re ready to do just about anything to feel like yourself again.

You’ve heard thyroid medication can help with energy, weight, and mood… But do you need it? is it safe? Will you become dependent on it? Is it better to wait and work on Root Causes first to try to avoid medication?

I get questions about thyroid medication pretty much every day and it’s great that you’re asking, too! The most common questions women ask me are:

  • What is thyroid medication, exactly?
  • How do I know if – and when – I really need to start one?
  • Do I have to take medication if I have hypothyroidism? What are the risks if I don’t?
  • Can I put if off taking it and instead keep trying to heal my root causes?
  • Does medication really make a difference in my health?
  • How will I know if it’s helping?
  • Is it safe?
  • Is taking it going to make me dependent on thyroid medication for the rest of my life?

In this article, I’m going to walk you through, step-by-step, my answers to each of these questions, which is how I help my patients with this big decision, and will hopefully help you, too.

What Is Thyroid Medication?

Thyroid medication, used for the treatment of hypothyroidism and Hashimoto’s, refers to pharmaceutical products containing thyroid hormones.

Thyroid hormone medications may include:

  • The inactive form of thyroid hormone, T4, which your body is then meant to convert into the active form T3
  • The active form of thyroid hormone, T3, which your body is meant to use directly
  • A combination of both T3 and T4.

These are natural or synthetic versions (derived from natural sources, such as dessicated animal glands) of the hormones your body should naturally produce, but is currently not producing in a large enough quantity, is not producing them at all, or is unable to convert from the inactive to the active form that your body can then use. These products may be time released, individually compounded, or have other nuances to them. In my book, The Adrenal Thyroid Revolution, I walk you through the various thyroid medication choices that are available and commonly recommended.

Thyroid Medication vs. Thyroid Hormone Supplementation

I prefer to use the term thyroid hormone supplementation over thyroid medication. While I don’t want to minimize the fact that these are pharmaceuticals, a lot of us bristle at the term medication, and even more so at the idea that we might end up on one chronically. Reframing what you call them can help you to feel more comfortable making the decision to use them should you need to. It’s also an important distinction, because thyroid hormone isn’t a foreign chemical designed in a lab to cause unnatural changes in your body. It’s a synthetic or natural version of the very same hormone your body is supposed to be producing to keep your metabolism, energy, mood, mental focus, and hormones humming at their best speed and effectiveness for your well-being.

Think of it this way: If you weren’t making enough Vitamin D (technically also a hormone, not a vitamin), you’d do your best to improve your diet and maybe get more sun exposure, but you’d probably also readily take a supplement if you needed it, for optimal health. So too that’s how I think of thyroid hormone. It’s a supplement for when your body just isn’t making enough, which might be for a time, or for the duration. It’s not a small decision, and it’s not something we should simply take as easily as walking into the store and getting Vitamin D, but my hope is to put it into a context that makes it easier to accept should you truly need it.

Thyroid Medication: How Do I Know If And When I Really Need It?

When determining whether you need thyroid hormone supplementation, the first thing to do is get a panel of hypothyroid testing labs including TSH, Free T3, Free T4 and TPO, and have these properly interpreted by a licensed health practitioner qualified to interpret labs. Here is a list of thyroid labs and and how I interpret them with my patients.

If Hashimoto’s or hypothyroidism are not demonstrable on your laboratory testing, then it is not appropriate to use thyroid hormone supplementation. Instead, it’s important to find out what’s causing these symptoms, as there are other conditions that can cause many of the same symptoms as hypothyroidism. If a practitioner suggests you start thyroid hormone supplementation without properly testing you, or in the absence of abnormal lab findings, find another practitioner, ASAP.

If labs do show that you have Hashimoto’s or hypothyroidism, then thyroid hormone supplementation can help. However, not everyone with hypothyroidism or Hashimoto’s needs thyroid hormone supplementation right away – or at all. Sometimes you can wait and see if your symptoms and labs improve over time without starting hormone supplementation.

How To Decide If-And-When You Need Thyroid Hormone Supplementation (a.k.a. Thyroid Medication)  

  1. When thyroid labs are only mildly out of the normal range as defined here, and your symptoms are mild, in other words, not notably affecting your health or quality of life right now, you may prefer to take a wait and watch attitude, with a plan for rechecking labs and reassessing the situation every 3-6 months with your care provider, and addressing your possible Root Causes. This is almost always the approach I take in my medical practice.
  2. If your thyroid labs are only mildly out of range, but you are very symptomatic to the point where your quality of life is affected or imbalances are showing up in your health parameters (i.e., you’ve gained a substantial amount of weight, you experience cognitive function changes like brain fog, or your cholesterol is elevated), then you might want to start thyroid hormone while looking for underlying and possibly reversible Root Causes of your hypothyroidism.
  3. When your labs are significantly out of the normal range (i.e., they are at or exceed even the conventional ranges discussed here in this article or in The Adrenal Thyroid Revolution, and you have no symptoms, you might consider a wait and watch approach as discussed in point #1 above, but if you are symptomatic, I recommend starting thyroid hormone supplementation while addressing Root Causes.
  4. If you’re pregnant and have high TSH or Low Free T4 or Free T3, there’s a good chance you need thyroid hormone supplementation. Speak with your doctor or midwife about this, and listen in here to learn more about thyroid in pregnancy.

Thyroid Medication: Can I Put if Off Taking It and Instead Keep Trying to Heal My Root Causes?

With patients who have lab results and symptoms that all support a diagnosis of mild Hashimoto’s or hypothyroidism, I often spend at least 6, and often up to 12 weeks helping them to identify Root Causes of the thyroid problem before we start thyroid hormone supplementation. I’ve had patients with low iodine and non-autoimmune hypothyroidism for example, who reversed their thyroid problem with iodine supplementation, and I’ve seen removal of gluten in patients with celiac disease reverse Hashimoto’s in a matter of months. Once we identify the Root Cause(s), we may then work to reverse these for several additional months, before starting thyroid hormone supplementation, and reassess regularly, usually every 6-12 weeks, based on symptoms and repeat lab results.

However, if your lab results are far out of the normal range, if your symptoms are impacting your quality of life, or if you’ve been working on Root Causes for 6 weeks or more and your symptoms haven’t improved at all, nor have your labs (or they are getting worse), this is when I generally recommend starting thyroid hormone supplement. It can be a game changer in how you feel. As one woman shared, “Getting on the right thyroid treatment at the right dose changed my life. It felt like the windshield wipers came back on in my brain and I could think clearly again for the first time in years!”

Of course, I recommend continuing to address Root Causes all the while, because these not only potentially led to the thyroid problem, but can lead to other health problems as well.

Do I Have to Take Medication if I Have Hypothyroidism? What are the Risks if I Don’t Take It?

Outside of pregnancy, there’s no hard and fast rule in conventional medicine that says you must take thyroid medication before the TSH exceeds 10 and you’re symptomatic. However, good quality scientific studies have shown that even slightly elevated TSH and mildly slow thyroid functioning is associated with higher risks of decline in both cardiac and cognitive functioning. Further, slow thyroid functioning associated with elevations in the “bad” type of cholesterol (LDL), and reductions in the protective type (HDL). Depression can also have a terrible impact on your life, and if it’s due to hypothyroidism, the right treatment can quickly turn this around. Therefore, in my medical practice, while I am not fast to jump on treating hypothyroidism with pharmaceuticals, I also weigh the risks of not treating seriously.

 Does Supplementing Thyroid Hormone Really Make a Difference?

Most women I work with who need – and do start taking – thyroid hormone experience a dramatic improvement in their mood, energy, hormones, sleep, weight, focus, and overall sense of well-being. If they’d been deeply exhausted and unable to participate much in their life, they often feel they’ve gotten their lives back. Further, studies show that women with even borderline low thyroid function as shown on lab tests, maintain better cognitive and cardiac function when treated with low dose thyroid hormone supplementation, suggesting a protective effect. 

How Will I Know if It’s Helping?

It can take several months to achieve the right dose of thyroid hormone supplement, and sometimes even a bit of trial and error to find the right product for you, but once you’re on the correct dose of the right thyroid product, you should notice symptoms improving rather quickly – often within days. Also, within about 6 weeks of reaching that right dose, a recheck of your thyroid labs, particularly your TSH, Free T3, and or Free T4 should show that the values are starting to come into the normal range. This is how you know it’s helping.

However, keep in mind, that if you have Hashimoto’s, thyroid hormone supplementation will improve symptoms because it is giving your body the tools to carry out thyroid function; it does not stop the autoimmune attack against your thyroid or prevent further thyroid damage. To do this, it’s important to address root causes and use supplements, such as selenium, which help reduce the antibodies attacking the thyroid and causing damage.

Is Thyroid Hormone Supplementation Safe?

If your body is not making or using the thyroid hormones you need for metabolism, brain, heart, and hormonal health then taking it is not only safe, but actually potentially very beneficial. However, caution is needed. Again, before taking thyroid hormone, confirm that you need it with proper laboratory testing.

Second, know the risks and benefits of the different types of thyroid hormone and the product(s) you’re taking. T4 supplementation has very little risk, unless you are over-supplementing, in which case, you can put yourself into hyperthyroidism which may sound fun if you’re feeling sluggish and slow – but can be dangerous. It can cause insomnia, anxiety, increased bone turnover (over time leading to bone loss), and importantly, can cause dangerous changes in your heart rhythm, causing too rapid a heart rate, and irregular heart rhythms!

T3 supplementation, which again, is taking the active form of thyroid hormone, carries more risks of sending you into hyperthyroidism and more quickly, so requires significantly more care in using it.

Is it Going to Make Me Dependent on Thyroid Medication for the Rest of My Life?

Contrary to what many people think, thyroid hormone supplementation does not make your thyroid stop working on its own, and does not make you dependent on the medication. However, many women who do need to start thyroid hormone supplementation will ultimately need to stay on it – but this is because by the time they started taking the medication there was already substantial destruction of the thyroid by antibodies that may have been present for years even before the Hashimoto’s diagnosis was made. Dr. Izabella Wentz, The Thyroid Pharmacist who also teaches people how to address the Root Causes of Hashimoto’s and hypothyroidism, herself has Hashimoto’s, and in a candid interview with me here, explains why she still requires daily treatment with thyroid hormone.

Some women can eventually discontinue taking thyroid hormone supplementation and there’s no clear way to predict who this may be, though having high anti-TPO antibodies for many years suggests a higher likelihood that you’ll need to stay on hormone treatment. If you’d prefer to be off thyroid hormone supplementation, you can work with your primary provider to see if this is possible.

Thyroid Medication: How Do You Know If You Still Need It?

Once you’ve been feeling great for several months, you can work with your primary provider to do a trial tapering down of your dose. This is done by slightly lowering the dose, and then testing your TSH, FT3, and FT4 about 6 weeks later; if they are out of range off the medication, you probably need to stay on it. If, however, you are staying steady in your labs, and without a return of symptoms, it may be possible to now take a lower dose, or continue the taper and rinse and repeat on the testing, to see if you can discontinue it.

In my medical philosophy, and personal life, I always try to take the non-pharmaceutical approach to health and healing whenever possible. However, I also recognize that we live in times when the impact on our health due to factors that may have even been beyond our control – for example, exposures to environmental toxins that can damage the thyroid – sometimes necessitate that we use the broad range of what’s available to us, including thyroid hormone support. Thyroid hormone support doesn’t mean we get to stop doing all of the other things it takes to feel great and be healthy like eating well, getting enough sleep, and making time for self-care, but it can give you the edge you need to get started on those if fatigue from hypothyroidism has been getting in your way. In fact, it can give you a new lease on life!

De Groot, L., M. Abalovich, E. K. Alexander, et al. 2012. “Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society clinical practice guideline.” Journal of Clinical Endocrinology & Metabolism 97 (8): 2543–65.

Haentjens, P., A. Van Meerhaeghe, K. Poppe, and B. Velkeniers. 2008. “Subclinical thyroid dysfunction and mortality: An estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies.” European Journal of Endocrinology 159 (3): 329–41.

McDermott, M. T., and E. C. Ridgway. 2001. “Subclinical hypothyroidism is mild thyroid failure and should be treated.” Journal of Clinical Endocrinology & Metabolism 86 (10): 4585–90.

Rodondi, N., W. P. den Elzen, D. C. Bauer, et al. 2010. “Subclinical hypothyroidism and the risk of coronary heart disease and mortality.” Journal of the American Medical Association 304 (12): 1365–74. doi:10.1001/jama.2010.1361.

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Belinda

Why do some doctors prescribe synthetic supplements like Synthroid verses a more natural supplement like Armor? Is it merely experience with the product or more specific physiological indications?

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    Aviva Romm

    Initially, Armous was actually all that docs had. Then synthetics became available - they were affordable and the dose was easy to regulate - and of course, Pharma does impressive marketing. But for a long time it was found or thought - I'm really not even sure which - that the natural products weren't reliable and consistent batch to batch. We now know they are, but most docs 1) Only learn about the synthetics and 2) still believe that only the synthetics are reliable. I use the whole range in my practice, and often start with Armour, though am comfortable with synthetics are well.

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    Debra

    Please tell me how to convince any Dr I have that the synthroid I was taking put 20 lbs in me in a short amt of time I can't find any Dr that will help or believe that it can happen any Dr I have has to take my insurance cause im also disabled can anyone help? Bethlehem PA,!

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CATRYNA WHITE

I was diagnosed with Hashimotos 6 years ago and this after a different doctor diagnosed me for Hypothyroidism, 7 years before. The first doctor had me try Armours, but after 10 days I started having heart palpitations and hives. He then tried Synthroid and that produced an increase in my migraines and depression. Years later with the new doctor, T4 was tried and that resulted in migraines and suicidal thoughts and then T3 was tried that gave me the sweats. I then had a change in diet (Gluten free) along with a modified vegetarian diet, Thyroid supportive supplements and Cannabis for autoimmune. These natural changes have made all the difference in the world.

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    Cheryl Kaczmarek

    Wow... Thank you Sooo Much for this information!

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susan

Thank you, this is great information, especially as I've just begun my journey in detecting and treating hypothyroidism. I have low range Free T3 and the compound T3 med I am taking has made a significant change to my energy (increase) and hair loss (it has almost stopped falling out after almost 18 month continuous). I am still digging into root causes, but find this support helpful in the meantime. I'm learning so much from your site and book.

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    Jenny

    Hello. Regarding the symptom and improvement of hair loss, in addition to the thyroid hormone supplementation, are you finding that you also need to take an iron and/or L-lysine supplement? I am presently experiencing a lot of hair loss (have not yet had my thyroid tested, but will soon), and am looking into other supplements. Thank you.

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      Aviva Romm

      Hi Jenny, Hair loss can be caused by a variety of factors from severe or chronic stress to nutritional deficiencies to autoimmunity (like with Hashimoto's). A few studies have found that ferritin levels below 70 are also associated with hair loss, and that a combo of iron and lysine can help. Having ferritin tested is very easy -any licensed medical practitioner can do it - and I don't recommend taking iron without knowing it's low. Best, Aviva

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Shirley Alberty

When I was 28 I had what the doctor told me was a cold nodule, a hollow growth that grew around my thyroid. So I had surgery and had growth and thyroid removed. I have taken medication since. I am faithful about going in every year and have a thyroid test done. I have never had to have an increase in medication. I do feel tiredness due to the loss of the thyroid. I have not as yet found a natural remedy that completely take the place of my thyroid medication as I have with my hormones I take due to my hysterectomy. I take Synthroid 100 mcg (0.1 mg). Thanks for the book you wrote. I have read it three times now and learn something every time I read it. Shirley

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Rosie

Thanks for this article Aviva. I was diagnosed with hypothyroidism and have been taking Dessicatted Thyroid at 115ml for approx 5 1/2 years. About a year ago I started getting a bunch of symptoms relate to hyperthyroidism (without realising it at first), I suddenly was anxious about everything, couldnt sleep very well, (normally I sleep great) had erratic fast heart rate at times (and usually in bed), hair loss etc. I am a yoga teacher and live and eat very healthy so couldn't understand what was going on. I suddenly had an onset of bad headaches for over a week and went to the doctor where I saw a 'fill in' doctor who right at the end of my appoinment noticed my previous thyroid blood tests (that my regular GP hadn't noticed) showed I was on the borderline in my range and suggested i went down half a tablet, which I did for a couple of weeks and then I self diagonised to go down another half and eventually 1 1/2 tabs, so now I am down to almost half of what the medication I was on and with follow ups on blood tests still feeling normal again. I am hoping to get off them completely, of course, but think I will have to purchase you rThyroid Revolution book to really research how to do this. While my doctor is quite proactive and happy for me to do my 'natural' way of life, she doesn't have the knowledge of how I can do this.. I would so LOVE to work with you. :-)

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Heather

Thank you for this article! I have a quick question...I am currently taking a VERY low does of WP Thyroid (1/4 grain). My FT3 is normal to high, but my TSH is high. When I started the medication, my TSH went up! Not good. I want to come off of the medication, but I am nervous to do so. How Do you recommend coming off of the medication safely? Thank you!!

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    Aviva Romm

    Hi Heather, Many if not most women do actually need to remain on it. Coming off of it really requires working with someone who can guide you so you can trend labs and symptoms to see if coming off is working for you - or what the lowest dose you can achieve and keep thyroid hormone levels normal.

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R

What a wonderfully written comprehensive guide to everyone with thyroid. Much appreciate the good work you are doing by putting the knowledge out there. Many thanks.

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Janine

I have unusual results, high TSH and the rest normal. But I've had open heart for an ASD repair and then A-fib (treated with an ablation). Since then I'm fine, no meds and I exercise, but my doctor will not give me Thyroid supplemention in fear of bringing back the A-fib. Is he justified?

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    Aviva Romm

    Hi Janine, with proper thyroid control, and proper medication use - rather than over-control which is a real problem that can cause a-fib - one should not see afib. An endocrinologist can work with you on proper dosing if you have high TSH and symptoms of hypothyroid without causing problems. But caution is important - many functional medicine doctors are overcontrolling with too high doses of medications and giving T3 alone, which can cause some problems.

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Joyce

Hi the link to locate a "licensed health practitioner qualified to interpret labs" Is missing from this this sentence... For a list of thyroid labs and their interpretation, head over here.

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    Tracy Romm

    Try this article - https://avivaromm.com/thyroid-labs-gap/

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Medically Cynical

I've been on it for over a year after a quick blood test and "oh you need this". Skin itching constantly after I take it. Rashes, not feeling well. I stopped taking it. Almost immediately the itching stopped, skin clearing up and the rashes gone.

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